April is talking on her cell phone in the hall and sounds angry. Paul is in his kitchen reading the paper when he hears her. He steps over to the door and listens a moments then goes into his office.
Paul tells April he is glad she is there. She contacted him by email. She wants to know if he has an iPhone charger. He says no and she asks to use the phone but agrees to wait until the session is over.
April has a tremor in her hand. She tells Paul that it runs in her family, getting a tremor when she is angry. She says it would help if she could use the phone. Paul tried again to get her to wait.
She is angry at Sienna who is Kyle's new girlfriend. April told Kyle she has cancer, he broke her confidence by telling Sienna who offered to pay for her treatment. She wants to be able to call Sienna back so she can hang up on her. Paul gets the phone. She asks Paul to give her a moment so he leaves the room. He waits a moment or two and then she comes to the door and they return to his office. The tremor has stopped.
April has told Paul that Kyle is the only person she has ever loved. Paul asks how it feels to see him with someone else. She says she hasn't seen them together but goes on to describe her. Paul asks about telling Kyle about her cancer. She tells him about telling Kyle, that he came over and she thought they could be friends and he kissed her as he left. She became aroused during the kiss and she began to cry and then he began to cry. He told her he is engaged and she told him she had cancer. The phone rings and they see it is Kyle. Paul tells her he won't answer. She goes on and says Kyle got angry with her after she told him because he said she was not taking care of herself.
Paul asks if she finds it hard to let herself be taken care of, that she tried to do her work and his as well when she is there. Paul says he thinks Kyle was appropriately anxious. Paul tells her that as soon as she told him last week that she had cancer she began to push him away as she did with Kyle when she told him. She tells Paul she broke it off with Kyle because she couldn't take how much he loved her, that it was too much. She tells Paul that her deepest bond is with her brother Daniel. Paul asks if she has told him and she says no, because of the struggles he has because of his autism. Daniel didn't deserve what he got. Paul asks if any of us deserves what we get. She tells Paul of episodes when she was with Kyle when she would realize she was feeling the way Daniel did, feeling alienated. She describes dissociating from her feelings. Paul tells her this and she asks what she was afraid of. And then says she slept with Kyle's best friend. That she didn't know why she did it, tried not to but did it anyway and then she told him and she couldn't forgive him. She couldn't deal with being the perfect girl to him. She hates girls like herself, hung up on her ex boyfriend.
Kyle has called every day. He offered to take her to chemotherapy. She hasn't taken the calls. Paul tells her she will need help. He asks if she would rather die than be weak, that she cannot get better without treatment. He wonders if he is her worry doll, that she can tell him and then she doesn't have to worry any longer and thus she doesn't have cancer. He tells her that talking with him will not make it go away. Paul tells her he talked with a friend who is an oncologist who told him avoiding treatment is suicidal. He tells her he has a professional duty to protect her from self-harm. She tells him he must promise not to talk to anyone else about her again, no matter what she decides. He agrees and says she must promise something in return. If she decides to stop therapy, she must call him, that he does not want her to disappear. She agrees thanks him and leaves.
Paul goes to his desk and writes a note.
Paul is very good with adolescents/young adults like Sophie from last season and April. And this session was no exception. He tries first to keep her within the session when she asks to use the phone, but when she persists and is able to tell him why, he yields -- because to continue to refuse might well have caused her to leave or at least be more resistant. He gently creates a temenos in which April is willing to talk about what happened with Kyle and to go further and reveal some of her feelings. He allows the session to build and near the end reflects to her that he believes she is trying to put all of her fear and worry into him so that she can go away believing she is well or getting well and not have to deal with having cancer. And he tells her that he has learned by talking with a friend who is an oncologist that it is a virtual death sentence if she does not get treatment. April resists hearing this by becoming angry that he spoke to anyone, just as she got angry with Kyle for telling Sienna. Paul tells her he has a professional responsibility to try to keep her from harming herself and she calms down a bit. This was a tough interpretation for him to make followed by a tough confrontation, but one that had to made. Because if Paul colluded with April by not confronting her refusal and by not interpreting the aim of her behavior, he would not be helping her in a meaningful way. She is angry with him because he doesn't collude with her but at the same time she is relieved. The part of her that really does want help recognizes he is right and so they arrive at their agreements -- that he will not talk to anyone else about her without her permission and she will not leave therapy without calling him.
It appears Paul is taking notes after the session now, with April. Not surprising given the risk she presents as if she does not seek treatment for her cancer she almost certainly will die. Whether Paul i consciously aware of the connecting here between Alex and April we can't be certain, but his anxiety comes out in the note because he feels the risk.